Ward_X

If you're talking about resolving an ABO with the presence of a cold, I've seen using warmed cells/plasma, adsorbed plasma, or cord cells. Did they use the anti-IgG for the workup, and not the discrepancy?

How does your facility comply with the newer AABB standard 5.16.2.2? Wouldn't compliance with having two determinations of an ABO group prevent erroneous admission?

I graduated from an MLS program in the last 5 years and I had two semesters of clinical chemistry, two semesters of clinical microbiology, one semester hematology, and one semester immunohematology. You can imagine my surprise when I came around in my clinical rotations and tried to grasp what an adsorption was, ha! Anyway, students tend to have a harder time going through Blood Bank for that reason.

From what I've seen, these patients normally have type-specific instructions for all products listed in their file. For example, for current in-process transplants, an OtoA Pos patient may have an O Red Cell Products instruction, an A or AB Plasma instruction, and an A, AB, or washed platelet instruction. If they have fully switched over to the donor type, their file notes that instead, and then it's type specific from there...

I have heard of facilities using TEG or ROTEM.

My facility uses Helmers and we have racks manufactured by Astron Systems. They store units vertically in sets of two or four. You can fit 4 across the length of a Helmer fridge in 2 rows (so 8 racks of 4, 32 total). In the Helmers with a higher bulk of products, we have some sort of plastic/acrylic dividers that section of units. We also have longer/heavier plastic "sleeves" that go down the length of the shelf, and those fit ~15 bags and go three across. So, I guess we have a lot of options! Intrigued to hear others!

Looking again at the Circular, FFP should be infused immediately after thawing, or discarded after 24hrs if not refrigerated. The Technical Manual references that components prepared in an open system require a reduction in expiry time from the time the system was opened. But, use of approved sterile collection devices maintains a closed system instead, allowing actions such as pooling or sampling to maintain the original expiration date/time. Thawed plasma is derived in a functionally closed system. I do not see any mentions of pooling in an open system -- only for platelets and cryo, with cryo having a 4hr outdate for an open system. The only mentions of pooled plasma was in regards to pathogen-reduced plasma, which had a 24 outdate from thaw. There is a section in the Technical Manual called Pooling under the Whole-Blood Collection and Component Processing chapter. You can also reference Table 9-1 Requirements for Storage, Transportation, and Expiration to see all the product types and their expirations. Are you talking about pooling for fractionation?

I can reply to this now that our Christmas Eve MTP has calmed down

I would ditto this, and add that after a certain amount of time (I don't recall how long), the unit electronically will move from "issued" status to "presumed transfused" status. So in our system, "issue" is the time of time stamp and sending it out of the Blood Bank. Whenever the care team wants to spike it is their problem.

If they're on topic and relevant to what you're being taught, I say ask them anyway. Trainers are there to teach, and questions are a huge part of that. If you're afraid that they think you don't conceptually comprehend the material, you can try reading the procedure first and then ask the question if you still have it. Additionally, I would suggest browsing MLS/med tech Facebook groups -- they can help a lot, even with questions you think are "silly." They're also pretty informal and sometimes have chat rooms.

Welcome! Learn all that you can, and take lots of notes . Eventually you will gain enough confidence to start contributing back to your lab. Help out where you can, volunteer to do the extra mile. Coming from another new MLS, I can acknowledge that our generation is brilliant, intuitive, and exquisitely savvy. However! We don’t know more than our coworkers who have been there for decades — use them!

In a grammatical sense, and from one who has studied Latin, isn't the usage dictated by the indirect object of the sentence? You're adsorbing bound antibodies to phenotypically known cell lines, and therefore interpreting the product that had antibodies pulled towards it. The whole point is to take off the antibodies (direct object) in a way you could identify them to selected RBCs (indirect object). Up for debate

@SMILLER and then how do you encourage staff improvement sans punishment based on your form process?

My facility seems to have a similar process in regards to gel screens. The only difference is that we perform the repeat screen before* proceeding to panels on patients with no previous history. Only when the repeat is positive or there is history is the panel performed. That ended up being a workflow decision that took some time to resolve, but moving to the performance of the tube screen first prevented gel-sensitive positives (that are only going to result as negative on panel) going straight to panel and getting fully worked up. As far as our result entry, positive gel screens do trigger an ABID test bar that has to be resulted. Our repeat screens in tube with negative reactions are resulted as No Antibody Detected (NAD), which keeps them EXM eligible. If the repeat screen is positive, and the workup moves to a panel, the ABID is resulted as the result of the panel. The repeat screen is billed as a "subsequent antibody screen with enhancement media," and we have two billing codes for standard panels (one billing for panels with 3 or less cells, and one billing for panels with 4 or more cells). TL;DR: Perform gel screen If positive... Does the patient have a history of antibodies? YES... proceed to panel rule-out. NO... proceed to step 2. If negative... result as negative. Perform PEG screen If positive... proceed to panel rule-out. If negative... result as NAD. Basically, the NAD to me seems like a dummy negative result to file. It means like a, "hey we did some reference work to see if there was anything, but there wasn't, but because we did a little more than just routine we can't just call it negative." Oh well.

I will preface my reply by saying I am not in a managerial position, just a tech in the lab. My facility has "Occurrence Reports" that record intentional deviations, reported errors, any workflow influence, etc. You can write them anonymously online or by hand. It's helpful at some points, but there's a fine line between people filling them out to report coworkers for silly things, or just filling them out when they feel "inconvenienced." I have a few problems with this process, but the form itself is outlined decently enough. It mainly just records the time a deviation is recorded, what area of the lab, what happened, corrective action, and future flow. Overall, I would say it comes down the culture of your lab. Who takes responsibility, and who places blame? If it's a workflow adjustment or something that takes less than 5 minutes to explain, or doesn't affect a patient in any way, emphasize communication between techs and talking to individuals directly to fix process kinks. Doing a whole roundabout where you report it and they find out weeks later about it through a form -- it's a little off-putting and not direct enough for cause and effect adjustment. If it's a real punitive-required situation, that's another problem. Complacency, which seems to be your mention, is something that starts to get into warnings, re-training, responsive action. If someone keeps incorrectly doing a test "their" way, force a re-train (people will want to avoid a whole session of teaching them how to do something they already know how to do, so maybe that's incentive).